Concerned about periods of incapacity or illness, the vast majority of Californians believe it is important to have their wishes for end-of-life decisions spelled out in writing through legal documents such as Advance Health Care Directives and Durable Powers of Attorney. Yet less than a quarter of Californians have actually completed such documents. The gap is especially tragic for poorer residents of long-term care (LTC) facilities, who may want to complete the documents before cognitive decline or failing health make it too difficult to do so, but who may not have access to support through an emotionally fraught and, often, confusing process.

In recognition of these challenges, in January 2017, the executive directors of Ombudsman Services of Contra Costa (OSCC) and Contra Costa Senior Legal Services (CCSLS) were awarded a $50,000 grant to work in partnership with La Piana Consulting to develop a multi-year plan that would allow OSCC and CCSLS to formally partner and launch a health initiative. The initiative would provide screening, education and legal services for residents of LTC facilities in Central and East Contra Costa Country who want to prepare and plan for issues related to periods of incapacity or illness.

In August 2017, the two organizations received grants totaling $243,000 – OSCC received $105,000 and CCSLS received $138,000 – that will allow them to launch the first phase of their 3-year collaborative plan of action. In brief, OSCC staff, as part of their normal activity of talking with and assessing the needs of LTC residents, will screen for individuals who do not have their wishes legally documented and will assess whether this is something the resident would like to do. If so, OSCC will facilitate a warm handoff and participate in an initial meeting with a CCSLS staff member to initiate the process. A joint CCSLS/OSCC case management team will meet regularly, on a case-by-case basis, to see the process through to completion for each individual.

In September 2017, CCSLS/OSCC were named beneficiaries of a $26,960 Executive Director discretionary grant to work in partnership with CHF staff and Harder+Company Community Research (Harder+Co) to design an evaluation plan for Phase I implementation of the initiative. In December 2017, the CHF contracted $73,600 with Harder+Co to conduct the evaluation.

In Phase I, to be completed from September 2017 through December 2018, the partners will:

Conduct a 12-month evaluation of the initiative with Harder+Co aimed at helping all the stakeholders understand: a) the process of program implementation and b) findings regarding the program’s initial impact.

Launch a pilot program focused on reaching 12-15 LTC facilities in Oakley and Brentwood, out of 31 in the area. During the pilot, the partners will screen approximately 100 residents in those facilities and provide legal services to approximately 30.